Check out my new blog YELLOW FEVER CASEBOOK: Historic yellow fever cases in Philadelphia and New York in the 1790's

Realizing that Laurie Anderson's book, Fever 1793, has generated much excitement among younger readers, and that perhaps not a few of the visitors to my web site were inspired by her book, I decided to provide:

A Historian's View of Anderson's Fever 1793

Historical fiction is a great way to learn about the past, and better yet, to get a feel for the past. Going through a novel and pointing out things that could not have happened somewhat misses the point of historical fiction. In the midst of the epidemic surely many people had a view of what was happening that was erroneous. Isolated and fearful, how could anyone know what was really going on?

However, Philadelphians in the 1790s were careful to keep records of their city. Before the epidemic a directory was published that gave the name and occupation of every head of household, listing each house in each street. After the epidemic, a list of all the dead was compiled, and a street by street, alley by alley, tally of the fever deaths was made. During the epidemic records were kept of admissions to Bush Hill hospital. Of course, we can't expect to find the fictional characters of Fever 1793 in these records. But we can get a better sense of the city at that time, even in regards to the most mundane things like the weather.

On August 16, 1793, Matilda Cook woke up moaning about another hot August day. Not far away Benjamin Rittenhouse kept a daily record of the temperature, wind direction and sky conditions at 6 am and 3 pm. Benjamin Rush thought weather was so important in trying to solve the mystery of the spread of yellow fever that he included the weather records for all of 1793 in his memoir of the epidemic.

(see the weather record for September-October.) So we actually know what the weather was, and that on the 15th it had not been a typical hot August day. At 3 pm it was 75 degrees and cloudy. At 6am on August 16 it was 70 degrees. So Matilda might have moaned about another muggy day, and while at 3pm, the temperature rose to 83 degrees, the wind shifted and came out of the north. Now this is nitpicking! But maybe not, with the causes of disease more mysterious in those days, many people thought wind direction had a great deal to do with health and moods.

The first dramatic event in Fever 1793 is the death of Polly. She is unable to come and work at the Cook Coffeehouse because the night before, August 15, she died suddenly at her parents' house on Third Street. At the Coffeehouse news of her death sets off speculation about the sickly state of the city, including deaths along the wharves

and illness among refugees from the West Indies. [These refugees came from the country now known as Haiti. Refugees from that country are sometimes in the news today so it should be noted that the refugees in 1793 were by and large well-to-do French settlers fleeing to safety, some with well cared for slaves acting as personal servants.]

Not surprisingly in many letters written at that time, the yellow fever epidemic is a major topic. However, in those letters no special attention was paid to deaths in the city until the last ten days of August. Anderson makes the reason for this clear in her book: death by fever in August was not rare. Indeed, Polly Lear, the young wife of President Washington's personal secretary died suddenly in early August. Biographers have wondered in retrospect if she was not the earliest victim of yellow fever. However, from my reading of the letters, the illness most remarked on in mid-August was an epidemic of the flu which was spreading throughout the city and beyond. It was not fatal, only a nuisance to be wheezing and coughing in the summer. Some blamed the refugees for bringing that to the city. As late as August 22 Benjamin Rush was worrying more about the influenza epidemic than the few fever deaths in the city that came to his notice. (For Dr. Rush's early fever cases see: account93.)

During and after the epidemic several doctors made a meticulous investigation of the fever deaths in early August to determine which might been caused by yellow fever. The earliest deaths were, by general consensus, deemed to be the deaths of two recent immigrants from Europe on August 6 and 8. Until the end of August both deaths were considered a mystery. Of course, it is possible that the general public gathered at coffeehouses were more aware of what was going on than the doctors. But there's no evidence for that.

Now, if someone like Polly had died suddenly on Third Street on August 15, would the doctors have included her among the early yellow fever victims? Probably not. Today the distance of three blocks seems insignificant. In the 18th century it was quite another matter, and rightly so. The Aedes aegypti mosquito which spreads yellow fever has a very limited range, under 500 feet. No one in the 18th century knew that but they were accustomed to the usual slow pace of the widening circle of infection as uninfected mosquitoes bit infected humans and thus became carriers of the disease giving it to the subsequent people they bit.

What first caused the panic in Philadelphia in 1793 was not the counting up of the number of deaths all over the city, it was the clustering of deaths of citizens of the city (not recent immigrants or refugees) and the violent nature of those deaths along the wharves. Rush, who lived just beyond Third Street on Walnut was at first perplexed at an early death he witnessed on Second Street, until he quizzed the family and learned the victim has been near the wharves frequently. Not until the last week of August, about August 26th, did families on Third Street get a sense that the fever had reached their door. Anderson makes good use of this in explaining why the Cook Coffeehouse was popular. It was over six blocks from the wharves. However, given the way people seemed to think in 1790s, if there was any suspicion that Polly had died of yellow fever, perhaps catching it as she visited the market for groceries, the coffeehouse where she worked would not have been popular. Indeed, it's likely that a real Mrs. Cook would have not have spoken about Polly's death at all, at least not to her customers.

We can get a pretty good gauge of when panic and flight would have definitely spread to the neighborhood of the Coffeehouse, because in real history, the Pennsylvania legislature was meeting nearby. They met on Wednesday August 28 and on Thursday adjourned until Monday. One reason was that, as one legislator wrote in his diary, "a young man by the name of Fry is lying dead at the west end of the State House." On Sunday evening, September 1, Dr. Rush was asked if it was wise for the legislature to convene. He advised against it and they met briefly only to adjourn and most members left the city.

One more brief point about the early days of the epidemic: the first group of people to be identified as particular victims of the fever were "young" men like Fry. Benjamin Rush wrote to his wife on September 1, "This evening I fear I shall lose a son of Joseph Stansbury, a sweet youth, a little older than our Richard. It has been particularly fatal to young people. I rejoice that our boys escaped from the city." Richard Rush was 13 years old. I kept expecting Matilda's boy friend, Nathaniel, to get the fever and die. By the way, I knew that Nathaniel's situation was largely fictional because his master, Charles Wilson Peale, was actually not in Philadelphia during the early part of the epidemic. He was down in Delaware Bay collecting specimens of birds, and returned to the city on September 16. Such are the little facts that historians learn by reading the letters written at the time of the crisis.

So a more likely scenario for Anderson's fictional heroine would have been for her to be unaware of any fevers until around August 22; then for her to hope, as many did, that the fever would not spread; and then for her to be in a panic when on August 28 her boyfriend Fry, who was the son of the doorkeeper of the State Assembly and thus a familiar figure in the neighborhood, died.

The Visit to the Newspaper Office. When characters in historical fiction visit the office of a real newspaper, the author quite lets historians in the door. Newspapers are one of the major sources used by historians, especially in studying events like an epidemic when things change day by day. Newspapers of that day combined several things, advertisements, of course, shipping news, letters from readers, copies of articles from out-of-town newspapers and foreign newspapers (often well out of date), and brief paragraphs written by the editor which often referred to current concerns. So we have a pretty good idea of what Andrew Brown, the newspaper editor whom Matilda's grandfather spoke with, was thinking during the epidemic. For example on August 31. Brown was "happy" to pass on "the assurances of several respectable physicians, that the progress of the infectious fever... is considerably abated." Matilda visited the office on Monday, September 2nd. What was on Brown's mind then? You can check copies of the Federal Gazette for that day. (When I find my copy, I'll let you know what it said!)

Mrs. Cook's Treatments

Matilda's mother got sick on September 2 and is first treated by a "Mr." Rowley. Then she is treated again on September 6 by a Dr. Kerr. Typically in those days the mother or grandmother in a house was the first physician. Unlike today, all the remedies that doctors had were also available to anyone else. A coffeehouse, especially, might be expected to have a cabinet full of medicines for many complaints of the day, and someone like Mrs. Cook might be expected to know how to use them. Not having an adult female friend with her, when Mrs. Cook became incapacitated to the degree where she could not treat herself, her father-in-law would have to get the medical help needed. That he would get a layman with dirty hands who smelled of rum is rather unlikely. Eliza somewhat excuses that by explaining to Matilda that all the real doctors are busy down at the wharves where "they say bodies are piling up like firewood." Actually, doctors did not respond to emergencies in such a fashion. Their first loyalty was always to the families they served. A system was in place that made the services of younger doctors available to those who did not have a family physician. A likely candidate for the Cook family doctor would have been Dr. Wistar who lived and worked a block or so away until he got the fever.

As it turns out Mr. Rowley prescribed a bath which was at that time one of the treatments for yellow fever. Baths were not common in Philadelphia in 1793, and giving a patient a bath every four hours was indeed drastic treatment. A more likely treatment, popular for a summer flu, was to soak the feet and sip camomile tea. When Dr. Kerr is summoned on September 6, Mrs. Cook is still unwell and lethargic. He says she has yellow fever and because her pulse is fast and strong, she must be bled because Dr. Rush advised such treatment.

Actually on September 6, Rush had not yet advised bleeding. One French doctor was bleeding yellow fever patients at that time. Rush began bleeding, in part because of cooler weather, on the 8th. Rush's treatment was calomel and jalap to purge the patient, which Dr. Kerr also advised. Purging was a violent evacuation of the body, "either up or down," as they used to say in the 18th century, and then after that the purge, broths, teas and other soothing medicines were prescribed. (For more on doctors' remedies published in the newspapers see: kuhn.) Obviously, doctors and medicines over 200 years ago were deficient. But it is unfair to misrepresent how doctors dealt with a patient. Today, a doctor often relies on medical tests to diagnose an illness. In 1793, there were no tests, only symptoms. After the epidemic Rush tried to simplify diagnosis, using the pulse, and simplify treatment, using principally harsh medicines and bleeding. In his account of the epidemic,

Rush went so far as to proclaim that training in the treatment of disease was "among the most essential articles of the knowledge and rights of man." He thought school children should be taught treatments for epidemic diseases. He claimed that, "All the knowledge that is necessary to discover when blood-letting is proper, might be taught to a boy or girl of twelve years old in a few hours." Well, obviously none of that came to pass, or else you'd be studying this chart from an old medical book!

Ironically modern medicine has used its superior knowledge of diseases to simplify its job. For example, if a doctor determines that a patient has a "viral infection" then there are no medicines prescribed, and the disease runs its course. Responding to symptoms only, eighteenth century doctors had a medicine for most everything. The modern approach can be risky if it leads to people taking virus too lightly. My four year old had a wicked bout of chicken pox, and at the time that was considered a mild childhood disease not warranting special treatment or even prevention. Then there were a lot more bad cases of chicken pox and that prompted doctors to develop a vaccine for that once benign childhood disease.

If Dr. Kerr acted responsibly, he would have paid very close attention to the symptoms of his patient. Visiting the patient more than twice a day was not out of question. In the early days when he was developing his remedies, Rush saw to it that his apprentice doctors kept patients under observation. Certainly a member of the family would be instructed on how to observe the patient and what to give to respond to what was going on. For example, Mrs. Cook would have been given calomel and jalap frequently until she was purged. However, whether she had an accompanying sweat was also important; as was the condition of her eyes, skin color, appetite. The pity of the 18th century was not that doctors were distant and dogmatic. The doctors were solicitous and caring. The pity was that their medicines were largely ineffective.

Mrs. Cook's trying to keep her daughter away was a common occurrence during the epidemic.

The Flight From Philadelphia

One of the great challenges of writing about the epidemic is how to describe what was happening in the city when it has been re-iterated over and over, since roughly August 30, 1793, that everyone who could fled from the city. Then there is another confusion. Much is made of armed guards keeping refugees from the epidemic away from outlying towns and villages. Then where did everyone leaving the city go?

And there is another way to look at it. The fever struck at the end of August, when not a few people generally were away to escape the heat of the city. In the case of the Rush family, mother and two daughters left the city for a vacation well before word of the epidemic. With news of the epidemic they did not return until November rather than sometime in September. Meanwhile Rush sent his sons to relatives in the country in late August.

I think we can take a common sense approach to this. Generally speaking, those in Philadelphia who had some relative or friend to go to just outside the city had no trouble leaving the city. Early in the epidemic, people probably could leave the city and find accommodations in country inns. When those became full, outlying towns had to fear an influx of possibly sick people with no place to go. In later epidemics the state solved this problem by creating tent cities for refugees near Philadelphia. At a certain point in 1793, roughly in the middle of September, it became widely held inside and outside the city that the city was so infected that anybody or anything coming from it had to be more or less quarantined. For that reason, many people in the city decided to stay so as not to embarrass friends and relatives.

Surprisingly, we cannot boldly state that at least no one came into the city after the middle of September. Philadelphia was the center of the Quaker faith in America. At the end of September they always held their "Yearly Meeting" in Philadelphia. So, at the height of the epidemic, Quakers came to Philadelphia to discuss the affairs of their religious society. They thought not to do so would be trying to thwart God's will, for He might have visited the city with pestilence, in part, to test the faith of Quakers.

All that said, I would suspect that if the Cooks had a definite place to go to, they could have easily made it to Gwyned. However, according to Mathew Carey's account of the epidemic, written in 1793, at some time during the crisis every road from the city was blocked. (For New York City's reaction see: nyc93)

Bush Hill The controversy over the best way to treat yellow fever has become one of the most remembered aspects of the epidemic. From the first instant histories to those written in the past few years, the battle between the doctors has been recounted. Modern historians usually can't resist taking sides, always at the expense of Dr. Benjamin Rush's therapies of purging and bleeding. Rush was very much responsible for this because he did not suffer to apply his remedies in silence. He so trumpeted the virtues of purging and bleeding that doctors ever since have been accusing him of killing his patients. Fever 1793 comes down on the side of Rush's opponents.

Unfortunately the critique of Rush is not strictly accurate. While Dr. Deveze did oppose Rush's approach, it was not bleeding per se that he objected to. In his memoir of the epidemic, Deveze describes how he frequently bled patients when their symptoms required it. How Deveze differed from Rush is that he did not take as much blood out at each bleeding, and he avoided violent purgatives. When patients' symptoms became grave, Deveze's extreme measure was to apply hot bricks to the extremities as well as greater uses of poultices to raise the skin in blisters. Applying those to the head required that the patient's hair by shaved off. (For portions of Dr. Deveze's memoir of the epidemic see: deveze)

In the Fever 1793, Matilda has her illness between September 12 and 20. The courageous exploits of Stephen Girard in making the hospital a place where people wanted to come, actually began on September 12. It took him several days to arrange it so Dr. Deveze would be in charge. He came to the hospital on the 16th and had complete control of medical operations on the 21st when the young American doctors were relieved of their duties. By the way, running such a hospital was not a desirable job for doctors. Deveze replaced four young Americans who visited the hospital periodically. Hospitals in those days were only for the poor; the poor were the principal victims in any epidemic; hence, a doctor worried about his reputation, stayed away from fever hospitals! Dr. Deveze had been in the city a little over a month and it would have been difficult for him to attract patients. He was ideal for the hospital. He did soon get an American associate, Dr. Duffield.

Matilda awoke as the nurse Mrs. Field tried to feed her. Going over my notes just now, I found an interesting note in the Minutes of the Committee in charge of the hospital. They passed a rule that a doctor would give food to each patient each day. This highlights the importance of food and drink in the treatment of disease at that time. (It also may have been a ploy to force the American doctors to resign. They insisted that after daily visits the nurses could be trusted to administer medicines!) Even Dr. Rush, who tried to simplify treatment, has particular ideas about which broths and drinks were best given to patients. (again see: kuhn)

Matilda leaves the hospital on September 24, twelve days after the on-set of her disease. Judging from the hospital records, other patients had similar experiences. However, others stayed in much longer. In 1793 there seemed to be three types of yellow fever cases: those who took it lightly and suffered some ill effects for a day or so; those who died within the first three days; and those who took a decided turn for the worse after the third day or so. Of course, many of the latter eventually died. Now, as I go through the collection of letters and memoirs I have about the epidemic, I'm curious if anyone who suffered the disease as severely as Matilda evidently did was able to be as active as she was in the rest of the book.

The Return to Philadelphia

During Matilda's cart ride to the orphanage Mrs. Bowles, a Quaker matron, told her "The streets of Philadelphia are more dangerous than your darkest nightmare. Fever victims lay in the gutters, thieves and wild men lurk on every corner. The markets have little food. You can't wander. If you are determined to return home with your grandfather, then you must stay there until the fever abates." Matilda does and her grandfather dies as a result of their fighting off two men trying to rob the coffeehouse.

Most descriptions of the city at this time highlight how quiet and empty the city was. Many described the city as being much like it was on a very quiet Sunday. Remarkably a number of city services remained. The Mayor and his special committee of volunteers met every day, and people could go there for help burying the dead, getting the sick to Bush Hill, or simply getting money or bread that the committee provided. The members of the committee also made visits to the homes of the sick to offer help. This was, indeed, amazing volunteer heroism and some the committee members died of the fever. The banks remained open, as did newspapers. The mail was delivered and when the mailmen became ill, letters could be picked up and dropped off at the Post Office. Because the mail service continued we have such a rich historical record of the epidemic. The city kept watchmen on the streets at night, their number augmented by volunteers. I believe the lamplighters continued to light the lamps. In his memoir Rush noted those professions that seemed to escape the disease: "three butchers only, out of nearly one hundred who remained in the city, died with the disease. Many of them attended the markets every day. Two painters, who worked at their business during the whole time of the prevalence of the fever, and in exposed situations, escaped it. Out of forty scavengers who were employed in collecting and carrying away the dirt of the streets, only one was affected by the fever and died...."

During the epidemic there were rumors of crime, but afterwards it was generally agreed that there were only two burglaries of empty houses, and both were minor. Philadelphians suffered immeasurably during the epidemic but crime did not add to their suffering. During most of September there were church services.

The African-American Nurses

Nursing was, and remains, crucial in the treatment of yellow fever. Early in the epidemic, Benjamin Rush explained to the leaders of Philadelphia's African American community that according to observations made during a yellow fever epidemic in Charleston some 50 years before, blacks did not get the fever. (Actually only those who had spent some time in Africa or the West Indies might have been immune, and many African Americans got the fever.) So Richard Allen, Absalom Jones and William Gray offered to provide nurses for the sick and to provide men to remove and carry the dead to burial grounds. Families could obtain nurses by applying to the Mayor. The demand became so great and the duties were so demanding that nurses were paid. (For more about this see Richard Allen's memoir at: allen)

From the letters I've read, it seems that these nurses were most valuable in sitting up with patients through the night. Of course, since they were paid by the patient's family, the nurses generally stayed with that patient until no longer needed. It's possible that there were people like Eliza who visited several patients a day providing what help they could, but as best as I can tell, women nurses generally stayed with one patient. There were many male nurses, too. Richard Allen and Absalom Jones, on the advice of Benjamin Rush, visited many patients and bled them. There was a shortage of professional bleeders during the epidemic. Finally a group of men specialized in removing the bodies of the dead. Incidently, I've seen nothing written at the time that suggests that the old refrain from the plague-days of England, "Bring Out Your Dead," was ever used in Philadelphia in 1793.

The End of the Epidemic

The most difficult days of the epidemic were the first two weeks in October. The daily death toll reached its peak of 119 on October 11. Chilly nights, though no freeze, didn't seem to slow down the epidemic. Then came cold nights, and people did indeed push their furniture and beds out doors to rid them of infection. However, the mosquito that spreads yellow fever can be a house mosquito so some people did get the disease after the freezing nights.

In her book Anderson makes the arrival of President Washington the signal of a return to normality. Governor Mifflin returned to the city several days before Washington. And most importantly, ships began moving up to the quays at the port and unloading their goods before either of those leaders returned. Today, government seems a full time operation. In 1793, Congress was in session from December until the late Spring. The state legislature met only a few weeks. The Mayor of Philadelphia never left the city. So, the most important symbol of health was the return to commercial business. As I understand it, Washington came to Germantown on November 1, to reassemble his cabinet, and came into Philadelphia for the day on November 11, against the advice of his advisors.

Many sources say that all officers of the federal government fled the city. Actually some Treasury Department clerks remained, and wrote several letters describing their ordeal. They tried to get to and from their offices without passing a coffin on the street or any sick person. In a sense that sums up the tragedy of the epidemic. People were torn between the need for isolation for their own survival and the need to help their suffering neighbors. Most chose the former path and so for most the epidemic, far from being the harrowing adventure that Matilda experienced, was a time of intense loneliness. Even in the letters of those families that stayed together, where parents and children stayed together, there comes across a sense of lonely waiting. Then sickness arrives and all is action and anxiety.

Of course, people who write long letters that are apt to be preserved for many years, are usually thoughtful rather than active people. So it is difficult to reconstruct the experiences of the thousands of apprentices left behind by their masters; of the thousands of workers with no jobs to go to; and of the thousands of families who found themselves huddled in the tiny rooms trying to survive.

Judging from Philadelphia's reaction to later epidemics in 1797, 1798, and 1799, the community did not wish to replicate the loneliness of 1793. Evacuation of the city became the watchword and city officials sought to make it organized and highly social. Tent cities were created with the crowding and camaraderie so familiar in today's refugee crises. In 1793 only Bush Hill hospital and the orphan house represented a communal response to a common enemy.

So as a historian I find faults with Fever 1793. But as a human being I applaud its effort to highlight community and hope.

Bob Arnebeck

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